
Cognitive Dysfunction in MS: Rethinking Assessment and Management
MS Compass: Guiding Clinical Care, a podcast hosted by neuroimmunologist Lindsay Ross, MD, brings you an exclusive interview with Rachel Galioto, PhD. [LISTEN TIME: 33 minutes]
Episode 3 of the MS Compass: Guiding Clinical Care®
MS Compass: Guiding Clinical Care is a NeurologyLive podcast led by Lindsay Ross, MD, a board-certified neurologist specializing in multiple sclerosis and neuroimmunology at the
In this episode, host Lindsay Ross, MD, is joined by joined by Rachel Galioto, PhD, a Cleveland Clinic neuropsychologist focused on neuroimmunology, to explore how clinicians can better recognize, assess, and manage cognitive concerns in people with MS.
Galioto discusses evolving evidence suggesting that the cognitive profile of MS may be changing in the modern treatment era, with memory and language difficulties potentially playing a greater role than historically appreciated. Ross and Galioto also examine how disease burden, sleep, mood, medications, pain, and other secondary factors can interact to affect cognition, emphasizing that cognitive dysfunction is rarely attributable to a single cause. The conversation concludes with practical guidance on medication review, addressing sleep problems, determining when formal neuropsychological testing is worthwhile, and using cognitive rehabilitation and compensatory strategies to reduce the impact of cognitive difficulties on everyday life.
EPISODE BREAKDOWN
- 0:00 – Introduction to cognitive dysfunction in MS and its impact on patients
- 1:00 – Defining cognitive dysfunction: brain fog, memory, word-finding problems, and processing speed
- 5:45 – Rethinking processing speed and limitations of the Symbol Digit Modalities Test
- 9:20 – How cognitive dysfunction changes across the MS disease course
- 11:20 – Lesion burden, brain atrophy, and the relationship between MRI findings and cognition
- 13:30 – Distinguishing MS-related cognitive dysfunction from secondary contributors
- 17:50 – How stress, mood, and other factors may amplify cognitive difficulties in MS
- 19:55 – Medication burden, polypharmacy, and therapies that may affect cognition
- 22:00 – Balancing cognitive effects with the need to effectively manage MS symptoms
- 23:00 – Sleep as an overlooked contributor to cognitive dysfunction and opportunities for intervention
- 26:00 – When clinicians should consider formal neuropsychological testing
- 28:45 – Using neuropsychological testing to guide rehabilitation, accommodations, and future care
- 30:15 – Key takeaways: addressing modifiable contributors and reducing the daily impact of cognitive dysfunction
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